UNITED STATES BANKRUPTCY COURT WESTERN DISTRICT OF NEW YORK In re: Case No. Chapter 13 Debtors DEBTOR'S VOLUNTARY CONSENT TO CONVERT FROM CHAPTER 13 TO CHAPTER 7 OR REQUEST FOR DISMISSAL TO THE COURT: I/we hereby voluntarily request the following relief: G Conversion of the above case to Chapter 7. The fee required by the Bankruptcy Court Fee Schedule is attached to this motion. (If not attached, I understand the conversion might not be processed until the fee is paid). A list of debts incurred after the initial filing of the above case is either attached to this motion or will be filed within 14 days. This motion has been served on the Chapter 7 Trustee and the United States Trustee. Dismissal of the above Chapter 13 case. (Available only to Chapter 13 debtors and only if this case was not previously converted). Dated: ____________________ _________________________________ Signature of Debtor ___________________________________ Signature of Joint Debtor Note: If the above case is a joint case and both debtors are seeking relief, both debtors must sign this document. If only one debtor is seeking conversion, an additional fee will be assessed to split the above case. (4/13/11) American LegalNet, Inc. www.FormsWorkFlow.com